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multimodal probe for optical coherence tomography epidetection and micron-scale indentation

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Journal of Innovative Optical Health Sciences 2017年第6期10卷 64-72页

作者： L.bartolini F.Feroldi J.J.A.Weda m.Slaman J.F.de Boer D.Iannuzzi Department of Physics and Astronomy Vrije Universiteit Amsterdam and LaserLab Amsterdam de Boelelaan 1081 1081HV AmsterdamThe Netherlands

We present a multimodal ferrule-top sensor designed to perform the integrated epidetection of Optical Coberence Tomognphy(OCT)depth-profiles and micron-scale indentation by all-optical detection.By scarning a sample under the probe,we can obtain structural crosse soction images and identify a region of interest in a nonhomogencous sample.Then,with the same probe and setup,we can immediately target that area with a series of spherical indentation measurements,in which the applied load is known with aμN precision,the indentation depth with sub-/m precision and a maximum contact radius of 100 pm.Thanks to the visualization of the internal structure of the sample,we can gain a better insi ght into the observed mechanical behavior.The ability to impart a small,confined load,and perfomn OCT A scans at the same time,could lead to an altemative,high transverse resolution,Optical Coherence Elastography(OCE)sensor.

关键词： Optomechanical microindentation optical coherence tomography indentation multimodal sensor,epidetection

Esophageal surgery in minimally invasive era

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World Journal of Gastrointestinal Surgery 2016年第1期8卷 52-64页

作者： lapo bencini luca moraldi ilenia bartolini andrea coratti division of oncologic surgery and robotics department of oncologycareggi university hospitalazienda ospedaliero-universitaria di careggi50134 FlorenceItaly

The widespread popularity of new surgical technologies such as laparoscopy, thoracoscopy and robotics has led many surgeons to treat esophageal diseases with these methods. The expected benefits of minimally invasivesurgery(mIS) mainly include reductions of postoperative complications, length of hospital stay, and pain and better cosmetic results. All of these benefits could potentially be of great interest when dealing with the esophagus due to the potentially severe complications that can occur after conventional surgery. moreover, robotic platforms are expected to reduce many of the difficulties encountered during advanced laparoscopic and thoracoscopic procedures such as anastomotic reconstructions, accurate lymphadenectomies, and vascular sutures. Almost all esophageal diseases are approachable in a minimally invasive way, including diverticula, gastro-esophageal reflux disease, achalasia, perforations and cancer. Nevertheless, while the limits of mIS for benign esophageal diseases are mainly technical issues and costs, oncologic outcomes remain the cornerstone of any procedure to cure malignancies, for which the long-term results are critical. Furthermore, many of the minimally invasive esophageal operations should be compared to pharmacologic interventions and advanced pure endoscopic procedures; such a comparison requires a difficult literature analysis and leads to some confounding results of clinical trials. This review aims to examine the evidence for the use of mIS in both malignancies and more common benign disease of the esophagus, with a particular emphasis on future developments and ongoing areas of research.

关键词： Esophageal disease Esophageal cancer Laparoscopic Robotic da Vinci Heller Reflux disease Esophageal diverticula

Role of gut microbiota-immunity axis in patients undergoing surgery for colorectal cancer:Focus on short and long-term outcomes

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World Journal of Gastroenterology 2020年第20期26卷 2498-2513页

作者： Ilenia bartolini matteo Risaliti maria Novella Ringressi Filippo melli Giulia Nannini Amedeo Amedei Paolo muiesan Antonio Taddei Department of Experimental and Clinical medicine University of FlorenceFlorence 50134Italy

Human body is colonized by a huge amount of microorganisms mostly located in the gastrointestinal tract.These dynamic communities,the environment and their metabolites constitute the microbiota.Growing data suggests a causal role of a dysbiotic microbiota in several pathologies,such as metabolic and neurological disorders,immunity dysregulations and cancer,especially the well-studied colorectal cancer development.However,many were preclinical studies and a complete knowledge of the pathogenetic mechanisms in humans is still absent.The gut microbiota can exert direct or indirect effects in different phases of colorectal cancer genesis.For example,Fusobacterium nucleatum promotes cancer through cellular proliferation and some strains of Escherichia coli and Bacteroides fragilis produce genotoxins.However,dysbiosis may also cause a proinflammatory state and the stimulation of a Th17 response with IL-17 and IL-22 secretion that have a pro-oncogenic activity,as demonstrated for Fusobacterium nucleatum.microbiota has a crucial role in several stages of postoperative course;dysbiosis in fact seems related with surgical site infections and Enterococcus faecalis(and other collagenase-producers microbes)are suggested as a cause of anastomotic leak.Consequently,unbalanced presence of some species,together with altered immune response may also have a prognostic role.microbiota has also a substantial role in effectiveness of chemotherapy,chemoresistance and in the related side effects.In other words,a complete knowledge of the fine pathological mechanisms of gut microbiota may provide a wide range of new diagnostic tools other than therapeutic targets in the light of tailored medicine.

关键词： Intestinal microbiota Colorectal cancer Chemo-resistance Therapeutic strategies

Impact of microbiota-immunity axis in pancreatic cancer management

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World Journal of Gastroenterology 2022年第32期28卷 4527-4539页

作者： Ilenia bartolini Giulia Nannini matteo Risaliti Francesco matarazzo Luca moraldi maria Novella Ringressi Antonio Taddei Amedeo Amedei Department of Experimental and Clinical medicine HPB Surgery UnitAzienda Ospedaliero-Universitaria CareggiFlorence 50134Italy Department of Experimental and Clinical medicine SOD of Interdisciplinary Internal MedicineAzienda Ospedaliera-Universitaria CareggiFlorence 50134Italy Division of Oncologic Surgery Department of OncologyCareggi University HospitalFirenze 50134Italy

The microbiota impact on human diseases is well-known,and a growing body of literature is providing evidence about the complex interplay between microbiotaimmune system-human physiology/pathology,including cancers.Together with the defined risk factors(e.g.,smoke habits,diet,diabetes,and obesity),the oral,gut,biliary,and intrapancreatic microbiota contribute to pancreatic cancer development through different pathways including the interaction with the immune system.Unfortunately,a great majority of the pancreatic cancer patients received a diagnosis in advanced stages not amenable to be radically treated and potentially cured.Given the poor pancreatic cancer prognosis,complete knowledge of these complicated relationships could help researchers better understand the disease pathogenesis and thus provide early potential noninvasive biomarkers,new therapeutic targets,and tools for risk stratification that might result in greater therapeutic possibilities and eventually in a better and longer patient survival.

关键词： Gastrointestinal tumors Hepatopancreatobiliary tumors Pancreatic cancer Gut microbiota Dysbiosis Cancer development Carcinogenesis

Gut microbiota and immune system in liver cancer:Promising therapeutic implication from development to treatment

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World Journal of Gastrointestinal Oncology 2021年第11期13卷 1616-1631页

作者： Ilenia bartolini matteo Risaliti Rosaria Tucci Paolo muiesan maria Novella Ringressi Antonio Taddei Amedeo Amedei Department of Experimental and Clinical medicine University of FlorenceAzienda Ospedaliero Universitaria Careggi(AOUC)Florence 50134Italy Department of Experimental and Clinical medicine SOD of Interdisciplinary Internal MedicineAzienda Ospedaliero Universitaria Careggi(AOUC)Florence 50134Italy

Liver cancer is a leading cause of death worldwide,and hepatocellular carcinoma(HCC)is the most frequent primary liver tumour,followed by cholangiocarcinoma.Notably,secondary tumours represent up to 90% of liver tumours.Chronic liver disease is a recognised risk factor for liver cancer development.Up to 90% of the patients with HCC and about 20% of those with cholangiocarcinoma have an underlying liver alteration.The gut microbiota-liver axis represents the bidirectional relationship between gut microbiota,its metabolites and the liver through the portal flow.The interplay between the immune system and gut microbiota is also well-known.Although primarily resulting from experiments in animal models and on HCC,growing evidence suggests a causal role for the gut microbiota in the development and progression of chronic liver pathologies and liver tumours.Despite the curative intent of“traditional”treatments,tumour recurrence remains high.Therefore,microbiota modulation is an appealing therapeutic target for liver cancer prevention and treatment.Furthermore,microbiota could represent a non-invasive biomarker for early liver cancer diagnosis.This review summarises the potential role of the microbiota and immune system in primary and secondary liver cancer development,focusing on the potential therapeutic implications.

关键词： Gut microbiota Immune system Liver cancer Primary liver cancer Colorectal liver metastasis Liver cancer treatment

minimally invasive surgical approach to pancreatic malignancies

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World Journal of Gastrointestinal Oncology 2015年第12期7卷 411-421页

作者： Lapo Bencini mario Annecchiarico marco Farsi Ilenia bartolini Vita mirasolo Francesco Guerra Andrea Coratti Department of Oncology Division of Surgical Oncology and Robotics Careggi University Hospital

Pancreatic surgery for malignancy is recognized as challenging for the surgeons and risky for the patientsdue to consistent perioperative morbidity and mortality. Furthermore, the oncological long-term results are largely disappointing, even for those patients who experience an uneventfully hospital stay. Nevertheless, surgery still remains the cornerstone of a multidisciplinary treatment for pancreatic cancer. In order to maximize the benefits of surgery, the advent of both laparoscopy and robotics has led many surgeons to treat pancreatic cancers with these new methodologies. The reduction of postoperative complications, length of hospital stay and pain, together with a shorter interval between surgery and the beginning of adjuvant chemotherapy, represent the potential advantages over conventional surgery. Lastly, a better cosmetic result, although not crucial in any cancerous patient, could also play a role by improving overall well-being and patient self-perception. The laparoscopic approach to pancreatic surgery is, however, difficult in inexperienced hands and requires a dedicated training in both advanced laparoscopy and pancreatic surgery. The recent large diffusion of the da Vinci® robotic platform seems to facilitate many of the technical maneuvers, such as anastomotic biliary and pancreatic reconstructions, accurate lymphadenectomy, and vascular sutures. The two main pancreatic operations, distal pancreatectomy and pancreaticoduodenectomy, are approachable by a minimally invasive path, but more limited interventions such as enucleation are also feasible. Nevertheless, a word of caution should be taken into account when considering the increasing costs of these newest technologies because the main concerns regarding these are the maintenance of all oncological standards and the lack of long-term follow-up. The purpose of this review is to examine the evidence for the use of minimally invasive surgery in pancreatic cancer(and less aggressive tumors), with particular attention to the oncological resu

关键词： Pancreatic cancer Pancreatic adenocarcinoma Neuroe

Evaluation of prognostic factors and clinicopathological patterns of recurrence after curative surgery for colorectal cancer

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World Journal of Gastrointestinal Surgery 2021年第1期13卷 50-75页

作者： Filippo melli Ilenia bartolini matteo Risaliti Rosaria Tucci maria Novella Ringressi Paolo muiesan Antonio Taddei Amedeo Amedei Department of Clinical and Experimental medicine University of FlorenceAzienda Ospedaliero-Universitaria CareggiFlorence 50134Italy

BACKGROUND Colorectal cancer is a common tumor with a quite high-related mortality.Despite the used curative treatments,patients will develop cancer recurrence in up to 50%of the cases and/or other primary neoplasms.Although most of the recurrences are discovered within 3 years from the first treatment,a small percentage is found after 5 years.The early detection of recurrence is crucial to allow further therapies improving patients’survival.Several follow-up programs have been developed but the optimal one is far from being established.AIm To evaluation of potential prognostic factors for timing and patterns of recurrence in order to plan tailored follow-up programs.mETHODS Perioperative and long-term data of all consecutive patients surgically treated with curative intent,from January 2006 to June 2009,for colorectal adenocarcinoma,were retrospectively reviewed to find potential prognostic factors associated with:(1)Recurrence incidence;(2)Incidence of an early(within 3 years from surgery)or late recurrence;and(3)Different sites of recurrence.In addition,the incidence of other primary neoplasms has been evaluated in a cohort of patients with a minimum potential follow-up of 10 years.RESULTS Our study included 234 patients.The median follow-up period has been 119±46.2 mo.The recurrence rate has been 25.6%.Patients with a higher chance to develop recurrence had also the following characteristics:Higher levels of preoperative glycemia and carcinoembryonic antigen,highest anaesthesiologists Score score,occlusion,received a complex operation performed with an open technique,after a longer hospital stay,and showed advanced tumors.The independent prognostic factors for recurrence were the hospital stay,N stage 2,and m stage 1(multivariate analysis).Younger ages were significantly associated with an early recurrence onset.Patients that received intermediate colectomies or segmental resections,having an N stage 2 or American Joint Committee on Cancer stage 3 tumors were also associated with a higher risk of liver recurr

关键词： Prognostic factors Recurrence Recurrence patterns Colorectal cancer Longterm follow-up Follow-up programs

Evaluating the best treatment for multifocal hepatocellular carcinoma:A propensity score-matched analysis

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World Journal of Gastroenterology 2022年第29期28卷 3981-3993页

作者： matteo Risaliti Ilenia bartolini Claudia Campani Umberto Arena Carlotta Xodo Valentina Adotti martina Rosi Antonio Taddei Paolo muiesan Amedeo Amedei Giacomo Batignani Fabio marra Department of Experimental and Clinical medicine AOU CareggiFlorence 50134Italy

BACKGROUND Hepatocellular carcinoma(HCC)is a common tumour often diagnosed with a multifocal presentation.Patients with multifocal HCC represent a heterogeneous group.Although Trans-Arterial ChemoEmbolization(TACE)is the most frequently employed treatment for these patients,previous data suggested that liver resection(LR)could be a safe and effective procedure.AIm To compare LR and TACE in patients with multifocal HCC in terms of procedurerelated morbidity and oncologic outcomes.mETHODS All patients with multifocal HCC who underwent LR or TACE as the first procedure between may 2011 and march 2021 were enrolled.The decision to perform surgery or TACE was made after a multidisciplinary team evaluation.Only patients in Child-Pugh class A or B7 and stage B(according to the Barcelona Clinic Liver Cancer staging system,without severe portal hypertension,vascular invasion,or extrahepatic spread)were included in the final analysis.Propensity score matching was used to adjust the baseline differences between patients undergoing LR and the TACE group[number and diameter of lesions,presence of cirrhosis,alpha-fetoprotein(AFP)levels,and model for End-Stage Liver Disease score].The Kaplan-meier method was used to estimate overall survival(OS)and disease-free survival(DFS).The outcomes of LR and TACE were compared using the log-rank test.RESULTS After matching,30 patients were eligible for the final analysis,15 in each group.morbidity rates were 42.9% and 40% for LR and TACE,respectively(P=0.876).median OS was not different in the LR and TACE groups(53 mo vs 18 mo,P=0.312),while DFS was significantly longer with LR(19 mo vs 0 mo,P=0.0001).Subgroup analysis showed that patients in the Italian Liver Cancer(ITA.LI.CA)B2 stage,with AFP levels lower than 400 ng/mL,less than 3 lesions,and lesions bigger than 41 mm,benefited more from LR in terms of DFS.Patients classified as ITA.LI.CA B3,with AFP levels higher than 400 ng/mL and with more than 3 lesions,appeared to receive more benefit from TACE in terms of OS.CONCLUSION In a small

关键词： Hepatocellular carcinoma multifocal hepatocellular carcinoma Liver resection Trans-arterial chemoembolization Guidelines Liver tumour management

早—中侏罗世的太平洋微板块和冈瓦纳联合古陆

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海洋地质动态 2002年第9期18卷 14-16页

作者： Annachiara bartolini 马桂红